H5N1, Bird Flu Updates
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Tracking Bird Flu Cases
Bird flu deserves its own thread for tracking suspected and confirmed cases. It's not the pandemic virus, but it is still an ongoing and significant threat because of its... Read More

Sep 5, '11

The Smart Science of "Contagion"

Dr. Ian Lipkin, balanced a consultative role on the movie with his responsibilities as director of the Center for Infection and Immunity at Columbia and co-chair of the National Biosurveillance Advisory Subcommittee.

We don't have crystal balls that allow us to tell you whether a virus is going to be pandemic, with high pathogenicity, or not. We do know the following: We know that we dodged a bullet on SARS, because SARS actually came through the United States, but it didn't get established here. We know that thousands of people died in China -- and I was in China; I saw the havoc it wreaked there. It was profound. And we know that if we were to have some sort of an outbreak -- or pandemic, worse yet -- in the United States, we don't at present have the tools that are required to rapidly ramp up some sort of a strategy for making vaccines and distributing them. Those are just the cold, hard facts.

We make influenza vaccines in chicken eggs right now, right? Which means we need, what, 300 million eggs, fertile eggs in order to make vaccines? That's insane! We have to change the way we do these things. Furthermore, much of the vaccine manufacturing has moved out of the United States, so when we needed lots of vaccine in 2009, there were people who ran out and couldn't make it for us. Do you remember that? We had contaminations of various facilities. That was a situation where that particular virus was not a major threat to humankind. But the next one may be.

The problem, of course, is that, if this happens two or three years in a row -- it happens with SARS, and it happens with H1N1, and it happens with H5N1 and so forth -- people say, "OK, every time we have a new flu season, you guys tell us the sky is falling, and then the sky doesn't fall." And at some point they also say: "All right, we're done with this hype." My argument is that if we actually make generic improvements to all these different platforms -- recognition of risk, response to risk -- then whatever it is, whether it's tuberculosis or SARS or flu or whatever, we'll be in a better position to deal with it.

Oct 9, '11

New H5N1 Human Cases in Indonesia

Yesterday, the Indonesia Ministry of Health announced the case of a young child from West Jakarta who died on August 25, 2011. This is the first case confirmed in Indonesia by the Ministry of Health since June 2011. (link)

And two young brothers from Bali were locally confirmed with H5N1 today. These two cases have not yet been verified by the Ministry of Health. (link)

The World Health Organization has posted an update on the two Indonesian children who died from the H5N1 virus earlier in the month (see Bird Flu Claims Two Lives On Bali).

Complicating this story, the mother of these two children died about a week later. But from media reports it isn't clear whether appropriate samples were taken for lab testing before she was buried (see Indonesia: Bali Bird Flu Suspect Dies, Suspect Cases Increase in Mataram).

For now, she remains an unconfirmed case.

Nov 3, '11

WHO: Egypt H5N1 Update

Yesterday, WHO announced the 569th officially confirmed case of H5N1. The 1 year old boy from Gharbia Governorate, Egypt, was symptomatic on September 17, 2011. He was hospitalized on September 21, treated with oseltamivir, recovered, and was released on September 25, 2011.

Family cluster of H5N1 infections in Bali in October - The mother and two children died

In mid October two siblings from Bali died from H5N1. A few days later the mother also died and has only now been reported by WHO (link) to have been infected with H5N1. This is largest cluster of WHO confirmed cases since the three family members in Pakistan in 2007. Unsurprisingly, WHO does not discuss the possibility of human-to-human transmission in this cluster.

Dec 4, '11

Another H5N1 Case in Egypt

On November 29th WHO announced another human case of H5N1 in Egypt. A 31 year old woman from Dakahlia Governorate showed symptoms on November 10 and was hospitalized in November 16th. As of November 29th she was still in intensive care with ventilation support.

In late November, a pregnant woman and her child from Dakahlia Governorate, Egypt developed symptoms on the same day on November 26 from H5N1 infection. They were both hospitalized. The mother died on December 3. The child apparently survived. Both individuals had exposure to sick and dead backyard poultry (chicken and turkeys).‬‪ (WHO link)
Dakahlia Governorate, Egypt, 29-year-old Male

On December 21, WHO reported another H5N1 case, a 29-year-old male also from Dakahlia Governorate in Egypt. He developed symptoms on 8 December 2011 and was admitted to the hospital on 15 December 2011. He died 4 days later on 19 December 2011. Investigations into the source of infection indicated that the case had exposure to backyard poultry. (WHO link)

What was NOT reported by WHO on December 21, was that the 29-year-old male from Dakahlia Governorate was the brother of the pregnant woman who died from bird flu on December 3, and the uncle of the child who survived the bird flu infection as reported by WHO on December 15. These three individuals constitute a family cluster. It is not certain if all were infected from a common exposure or if limited H2H transmission occurred.Bao'an District, Shenzhen City, Guangdong Province, China, Bus Driver

In the past 72 hours, media reports in China identified a 39-year-old bus driver from Shenzhen City who was infected with H5N1. He was symptomatic on December 21, hospitalized on December 25, and died on December 31, 2011. Chinese media reports are conflicting on how he contracted the H5N1 infection. Contact tracing has been initiated, but so far no other human cases of H5N1 infection have been discovered. Detailed tracking of this case can be found at this FluTrackers link.

Jan 3, '12

A Summary of Worldwide Human H5N1 Cases in 2011

I have prepared an overview of human H5N1 infections in 2011.

Abstract - In 2011, 59 human cases of H5N1 were reported from around the world, a 23% increase over 2010. Five countries reported cases in 2011, Bangladesh, Cambodia, China, Egypt, and Indonesia. Almost half of the 59 cases (about 45%) were children under 10 years old. The fatality rate did not appreciably decline in 2011, about half of all the reported cases died. Four small family clusters were noted during the year. The source of exposure for all of the cluster cases has been reported as exposure to sick and dying poultry. None of these clusters resulted in sustained human to human transmission. Based on an analysis of the 2011 data, the potential for a virulent H5N1 pandemic has not diminished.
. . . .

Why did Paul Keim, chair of the National Science Advisory Board for Biosecurity (NSABB) say “I can’t think of another pathogenic organism that is as scary as this one”. What lead Donald McNeil, writing about H5N1 in the New York Times, to conclude that “In its natural form, it is known to have infected only about 600 people since its discovery in 1997, but it killed more than half of them.”

To know the fatality rate of avian H5N1 influenza virus in humans, we need to divide the number of fatalities by the number of infections. We do not know that last number – but there are hints that it could be quite large. In a recent study of rural Thai villagers, sera from 800 individuals were collected and analyzed for antibodies against several avian influenza viruses, including H5N1, by hemagglutination-inhibition and neutralizationassays. The results indicate that 73 participants (9.1%) had antibody titers against one of two different H5N1 strains. The authors conclude that ‘people in rural central Thailand may have experienced subclinical avian influenza virus infections’. A subclinical infection is one without apparent signs of illness.

Until we know how many individuals are infected with avian influenza H5N1, we must refrain from making dire conclusions about the pathogenicity of the virus. Doing so has only lead us down a dangerous path of fearing that H5N1 influenza virus might be used as a weapon of bioterrorism, and restricting the publication of scientific papers on the virus.

Influenza can infect both birds and mammals. Consuming a meal of an infected bird or animal uncooked will lead to illness and probable death for mammals including humans. There is quite a history of animals being infected if you read some of these links. The point to remember is that bird flu mostly infects birds but other species are susceptible as well.

I remember being very surprised when I read of this occurring in Indonesia when Dr. Andrew Jeremijenko found virus in a feral kitten while he was working for NAMRU 2 (the US Naval research station there). He was testing the birds and, only tested the cat out of curiosity. What do you know? The kitty was positive.

Andrew Jeremijenko, head of influenza surveillance at the US Naval Medical Research Unit 2 in Jakarta, Indonesia, detected H5N1 in a kitten he found near a poultry outbreak in Cipedang, West Java, and tested out of curiosity on 22 January. The virus from the kitten is closely related to recent H5N1 strains isolated from humans in Indonesia: it shares genetic changes found in human strains that are not present in samples from birds.

Quote from http://scienceblogs.com/effectmeasure/2006/08/questions_raised_by_latest_ind.php.com

Aup and his cousin fed the poultry carcasses to dogs. Published reports make it fairly certain that domestic and large cats eating infected meat have become infected and are able to spread the disease horizontally (from cat to cat). Millions of infected poultry are also being eaten by other mammals (and probably non mammals), but we have no systematic surveillance of other species for infection with this virus. We expect that the discovery of wild birds in North America infected with high path H5N1, when and if it occurs, will again raise the issue of infection via the gastrointestinal route. We hope so. An honest examination of this question is needed, not just a reflexive spinning as a way to protect the poultry industry.
But the issue goes beyond that, to questions of other animal reservoirs of the virus.